Occupational health: A specialty worth fighting for?

The numbers entering occupational health and occupational medicine are falling rapidly, and two-thirds of those left are aged over 53. So how do we stop this decline and create a specialty fit to tackle current and future workplace health challenges? It is about OH understanding, and better articulating, its value, skills and importance, argues Mandy Murphy.

It is well-recognised that, as occupational health nurses, we nowadays work within a wide variety of professional teams. There is, of course, nothing wrong with a multi-professional occupational health specialty; actually, I believe it is probably the one thing that is going to help maintain the strength of the specialty as it is.

But I am also increasingly seeing a blurring of the boundaries between what we all do as different professionals. We are all trying to do everything, and the risk is we are perhaps forgetting what it is that we uniquely bring to that table.

About the author

Mandy Murphy is deputy head of the National School of Occupational Health at Health Education England

Therefore, I strongly feel that, as OH nurses, we need to start thinking about, and articulating better, what it is specifically that we do. How do we articulate our particular wisdom? It is about not losing sight of the specialist part of what we do, about holding on to what it is we are trained to do, because we all have unique skills and competencies.

This also needs to be articulated more clearly to employers. How does an employer know who – specifically – to engage or contract with when they’re they faced with the challenge of rehabilitating someone who has been off sick back into work or managing a complex health and safety risk? Which professional skills are best placed to do that for them?

Care is becoming more complex and, with an ageing population, more people have multiple chronic and long-term conditions. Yet at the same time we are challenged by massive vacancies and nurses leaving the profession. In fact, leavers are currently outnumbering joiners by around 3,000 a year, which means that we risk having an empty pot if we’re not careful. Moreover, 64% of our professional workforce is over the age of 53. So, in five to 10 years’ time we could be looking at even wider gaps.

Slump in number of trainees

From an occupational health perspective, the Council for Work and Health has suggested we require 47,050 professionals to support the health needs of our future working population. Yet, within occupational medicine we are down in trainees by 62% from 2005.

There are, of course, many factors behind this. Brexit, certainly, is a talking point, but it is also about working conditions, workload, culture and pay. There is, too, a question about the extent that revalidation might be having an impact, and whether some nurses approaching retirement are deciding to go early because of not wanting to go through the process and paperwork of revalidation.

This is compounded by the fact a lot of the industry posts for training doctors and nurses have closed following the financial crisis as organisations have refocused their businesses. What is positive is that in the last recruitment round I observed for occupational medicine, we saw a really good calibre of doctors looking to specialise in occupational health – but we did not have enough posts for them. So we’ve got to start thinking now about how can we support and engage employers to create more training places so we can hold on to some of these people who are interested in coming into the specialty.

We have also seen a 43% drop in the number of occupational health degree programmes run by universities since September last year. In 2009, which was the peak for occupational health training, there were 203 nurses in occupational health training. But for 2018/19 this is down to 83. Again, this decline is something we need to be mindful of.

So, given that all healthcare specialties are fishing from a small pond of trained professionals – and that pond is shrinking – how do we attract the people who are interested – and the good ones of course – into occupational health? What is it that makes occupational health attractive? Is occupational health “sexy” enough, how can it bring new blood into the system?

Using skills better

In an environment where our numbers are so scarce, we also need to be thinking how do we embrace technology better? Are we spending too much time on triaging forms that an IT system could in fact do? Are we doing tasks that might be better suited to other colleagues such as OH technicians or support workers rather than applying our specialist skills where the need is? Are we spreading ourselves too thinly?

Graham Norton has a quote about fashion: “just because it fits, doesn’t mean you should wear it”. I often think that, just because you can make an appointment for somebody or fill in a form does not mean you have to spend your time doing that. It is just about how can we think differently about what we do, and how we do it. We need to be looking at what it is we are spending our time doing, how that can be done more efficiently, and making better use of technology available.

Part of this comes back to working more effectively in a multi-disciplinary way; we must start to move much more towards a team-based approach. But, crucially, in that environment it is even more important that your wisdom as an occupational health nurse stands out. What, again, is it that you bring to the table in terms of being an occupational health nurse? And it is about being proud of that and standing up and shouting about it.

Where does this all fit in terms of the future of nursing, and OH, education? I don’t have a crystal ball, but I do have some ideas.

We undertook a review back in 2017 around what was the state of play in terms of the education programmes out there. And we found that entering into occupational health is really complicated. Too many of us just fall into occupational health. And for those who are interested in occupational health as a career, there is not a lot of information out there to point you in the right direction. There are, too, a very wide variety of programmes and levels of qualifications out there.

On top of this, support for trainees is really complex. We do not have enough practice teachers out there; we do not have enough clinical supervisors. You hear people asking, “do you know anybody in this region who can act as a practice teacher?”. At the National School of Occupational Health (NSOH) we are looking at how we can support that, but there are no easy answers.

What needs to happen? I think we need disruption. What do I mean by that? We look at how Ryanair changed the way we travel; the low fares approach actually opened up the world to a lot of people. Amazon changed the way we shop. And Metro Bank was quite risky in terms of setting up a bank right at the time of the recession in 2010, with a focus on the customer rather than on how the bank operates and the back office.

I think we can learn from that. We need to think how we can disrupt the education side of occupational health to meet the needs of how the workplace – and workplace health – is evolving and changing. We can’t continue thinking that education is something you do once and then you’re done; that you do a course and that’s it, you’re qualified, specialised and off you go.

We need to think about education as a lifelong learning approach; we need to look at the study you require for the skills, the competencies, you need and how then to build on that when you move within an industry or between jobs.

Alternative learning methods

We should be embracing alternative learning methods; we need to be thinking about how younger generations are learning. This isn’t traditionally sitting in class in university for two years; it’s a blended approach with online work, conversation clubs and so on. Do we need centres of excellence? At the moment, for example, we have eight universities across the UK running educational programmes. But, actually, do we need that many? Can we create a model where delivery and quality are under one umbrella?

The other thing for me is about businesses taking more responsibility for education. Quite often we see people going into industry and they are not supported for ongoing education. If an employer is not NHS and they are taking on a nurse or a doctor, education has got to come with the job description; we have to stand up for that. We have to say that, as part of maintaining your code and being validated, as part of maintaining your professional experience and expertise, education has to be part of that role. We need businesses to be more engaged in supporting and educating.

Finally, I want to touch on the role of apprenticeships within this. At NSOH we are supporting the development of apprenticeships for occupational health nursing, and for those on SCPHN Part 3 of the register. It is not the answer to all our woes but I do feel this is a way to engage employers into training. The introduction of the apprenticeship levy has made this more attractive because it means an employer that provides an apprenticeship can reclaim the education cost through the levy. But within this it is vital that we establish a clear quality framework. What do we want the education programme to look like so there is a baseline for standards and competency?

The OH workforce and training challenge is about how we harness the energy that has always existed within the nursing profession. How can we maintain it and, crucially, not put people off considering occupational health nursing as a career? Ultimately, we need to look at innovative and creative solutions, as this is a challenge that is becoming increasingly urgent.

This is an abridged version of a presentation Mandy Murphy gave to the Royal College of Nursing and Society of Occupational Medicine (SOM) occupational health nursing conference.

Great post. It is necessary and fundamental indeed to have well-trained OH doctors and nurses. Workers need to be well taken care of, not just regards to common health diseases but the risks the may face in theirs respective work place and the potential professional diseases the may develop.